Carotid Endarterectomy

Carotid Arteries
The carotid arteries arise from the thoracic aorta and travel up each side of the neck to supply blood to the brain. Atherosclerosis-induced plaque can build up and partially obstruct one or both carotid arteries, causing arterial narrowing (carotid stenosis), decreased blood flow, cognitive problems, and an increased risk of stroke. Small particles of plaque or a blood clot that forms on the plaque can also break free, travel up into the brain, and block a smaller artery in the brain. The procedure that vascular surgeons use to remove plaque from narrowed carotid arteries is called a carotid endarterectomy.

Indications for Surgery
Patients who are referred for carotid endarterectomy may already be showing symptoms of inadequate blood flow to the brain. Treatment is determined by the size and location of the blockage(s) in consideration with the patient’s overall health and health history. Duplex ultrasound is often used to determine the severity and location of the lesions, and other imaging tests may also be used to make a complete diagnosis. Surgery is necessary to prevent further blockage or a blood clot—induced stroke. Patients who suffer from carotid artery disease are strongly urged to quit smoking, and this is especially important after surgery to prevent recurrence of the problem.

Surgical Procedure
Carotid endarterectomy is a major surgery that is performed under general anesthesia by a vascular surgeon. It has been performed routinely since the 1960s. The procedure takes 2 to 3 hours and is very effective, especially for patients who have started exhibiting symptoms such as memory loss and confusion. The surgeon makes a small incision in the patient’s neck to expose the artery, clamps the artery to stop the flow of blood, and then opens the artery length-wise to remove the plaque. During the procedure, the brain receives blood from the opposite carotid artery or from a bypass tube that reroutes blood flow around the blocked area. After the plaque is removed, the artery is closed and blood flow is restored. The incision site is then closed. The recovery period includes 1 to 3 days in the hospital followed by several weeks of healing time.

Alternative Procedures
Some patients may be candidates for a new procedure called carotid angioplasty with or without stenting. This procedure is similar to that done in the coronary arteries of the heart, and involves opening the artery with the use of a balloon expansion device and then placing a stent in the artery to hold it open. This procedure is done percutaneously in a special procedure room.


Resources

The Society for Vascular Surgery http://www.vascularweb.org/patients/NorthPoint/Carotid_Endarterectomy.html
Medline Plus www.nlm.nih.gov/medlineplus/ency/article/002951.htm